PDA

View Full Version : Hi everyone!



pilar
12-09-2009, 03:04 PM
I haven't posted any threads because I have been trying to forget about the surgery. I was schedule to have my surgery Aug. 24th, but my insurance had a cap of 50,000 dollars, so my surgeon didn't agree to do it. Therefore, I'm still here with my 90 degree curve. Since my insurance wouldn't be any helpful for me, I stopped paying and now I have no insurance and no hope for surgery. I am concentrated in finishing school at the moment, and waiting for Health reform changes. We will see next year...
I do have a question though, For the people living in California, what kind of health insurance do you have? do you have it from work? Is it possible to just shop for heath insurance online or anywhere if you are just a student?
The insurance that I had from school didn't work for me, and I am unemployed at the moment cause I want to focus in school, so I just live off my grants and student loans. I just want to know if I have any chances to acquire a good heath insurance that will cover spinal surgery on my own.
Thanks guys!
Pilar ;)

titaniumed
12-09-2009, 04:10 PM
Hi Pilar

Having good health insurance is necessary if you need expensive surgery. I believe you found this out.

Having scoliosis and timing surgery means that you have to time your insurance accordingly. When I was younger, I went through periods without insurance, and of course it made me jumpy. When was I going to have my surgery????

The best way to do this is to be on a group plan. Usually group plans have no pre-existing clauses. Its best to be on a group plan in the state that you intend on having surgery. Leaving the state will complicate matters, depends on the policy.

If you can get a job that has good insurance, and maybe go to school at night, that might work, or visa versa. Buying your own insurance will require a physical and will trigger a flag. No insurance company wants to cover you. No employer wants their premiums jacked up. If the employer and insurance company do not know about your needs for a very expensive surgery, that's the best scenario. Its tricky, if you ask too many questions about your policy bennies at your job interview, that also triggers a flag.

I have a total of $2,400,000. worth of insurance. I used approx $1,000,000. in 5 surgeries total.

Insurance is actually worth more than the salary if you need surgery.

Timing is tricky. If you get on a group plan and are eligible on the 90th day, running to a surgeon on the 91st day might be an issue. Food for thought.

I hope you can keep your pain in check.

Good luck
Ed

hdugger
12-09-2009, 04:46 PM
Hi Pilar,

I'm assuming you're over 25 (or whatever the cutoff is on your parent's insurance plan)? If not, your parent's plan would cover you for as long as you're a fulltime student and under the cutoff age.

A few other thoughts we've had, as our son nears the cutoff age for surgery:

* Have you thought about moving to Massachusetts? I haven't looked at their health plan in detail, but I do know that they have the most progressive health insurance in the country. It might be worth investigating.

* Have you thought about having your surgery done overseas? Again, I have zero leads on this, but I do know that there is some very good surgery available in Thailand and India. I have no idea if there are good scoliosis surgeons, but, again, it might be worth checking into.

* Have you thought about marrying someone with insurance? Again, an extreme recourse, but these are extreme times. Most plans will cover a newly acquired spouse.

* Have you thought about directly approaching a teaching hospital or religiously-based hospital and seeing if they'll take you on as a charity case?

Very best wishes on your search, and please let us know how it pans out.

hdugger
12-09-2009, 04:49 PM
Oh, I missed one:

* If you have a history of working (it's something like making $4000 a year for 5 years, but I'd check for the real numbers) you could think about applying for disability. Again, depending on your pain level and how much the scoliosis affected your day to day life. After some waiting period, disability insurance includes medicare/caid (can't remember which) coverage.

CHRIS WBS
12-09-2009, 05:42 PM
* Have you thought about moving to Massachusetts? I haven't looked at their health plan in detail, but I do know that they have the most progressive health insurance in the country. It might be worth investigating.




Oh really? If itís so progressive, why are health care costs in that state rising much faster than the national average? I have a sister who is a nurse and lives just outside Boston. Iím hearing plenty from her, everything from skyrocketing premiums to increased waiting times to see a physician. Massachusetts is a prime example why government intrusion into health care does not work.

loves to skate
12-09-2009, 06:58 PM
I haven't posted any threads because I have been trying to forget about the surgery. I was schedule to have my surgery Aug. 24th, but my insurance had a cap of 50,000 dollars, so my surgeon didn't agree to do it. Therefore, I'm still here with my 90 degree curve. Since my insurance wouldn't be any helpful for me, I stopped paying and now I have no insurance and no hope for surgery. I am concentrated in finishing school at the moment, and waiting for Health reform changes. We will see next year...
I do have a question though, For the people living in California, what kind of health insurance do you have? do you have it from work? Is it possible to just shop for heath insurance online or anywhere if you are just a student?
The insurance that I had from school didn't work for me, and I am unemployed at the moment cause I want to focus in school, so I just live off my grants and student loans. I just want to know if I have any chances to acquire a good heath insurance that will cover spinal surgery on my own.
Thanks guys!
Pilar ;)

Hi Pilar,

I am so sorry for your situation.

I say shame on the Doctor for not accepting your $50,000.00 worth of insurance. My Doctor bill for my surgery was $55,000.00 and that included a 12 hour posterior and a 7 hour anterior. I know that Doctors can charge anything they want for scoliosis surgery, but I would bet money that my surgeon would have accepted your $50,000.00 in a heartbeat because I am on Medicare and he only got about $15,000.00 from my Medicare Advantage Plan and about $1,500.00 from me. There are other Doctors out there that are a little more benevolent than the one you saw. You should have shopped around more before you gave up on getting the surgery and giving up your insurance. Now you have no insurance and a pre-existing condition that can be rejected by a lot of insurance companies. I hope you get the result you want from health care reform, but I am of the belief that it won't be what you want it to be, nor will it be what I want it to be. They will be taking away from Medicare to give to those who haven't paid into the system and that doesn't make me happy. I'm glad I have already had my surgery because I am afraid if I didn't, they would tell me I am too old if health care reform goes through.

Anyway, good luck to you.

Sally

hdugger
12-09-2009, 07:11 PM
Be that as it may, if one is without insurance and has a serious medical issue, one might put aside the political debate for a moment and go somewhere where they could be treated.


Oh really? If itís so progressive, why are health care costs in that state rising much faster than the national average? I have a sister who is a nurse and lives just outside Boston. Iím hearing plenty from her, everything from skyrocketing premiums to increased waiting times to see a physician. Massachusetts is a prime example why government intrusion into health care does not work.

pilar
12-09-2009, 07:48 PM
Thanks for your responses. Sorry, I didn't want to make this a political debate.

JenniferG
12-09-2009, 10:08 PM
Pilar, I was sorry to read of your situation. It sounds like there are still some possibilities there for you. I hope you find some way of overcoming the hurdles to your surgery. 80 degrees is quite worrisome and, I would expect, needs to be treated before too long. Please don't lose contact, and let us know how you fare.

Doodles
12-09-2009, 10:17 PM
Pilar--Your post is terribly sad. I watch & follow the health care debate and hope something is done for all the people like you in similar circumstances. I was lucky to have a really good insurance or I don't know what we would have done. Janet

sccrm08
12-10-2009, 12:21 AM
Pilar - You are in California...correct? I have Kaiser medical insurance and would not change unless I was forced to. My husband changed jobs a year ago and that was top on my list. I receive nothing but the best care. I know many people don't think well of Kaiser but they have always been there for me, sometimes they are a little slow but they do come thru. I beleive you can pick up an individual policy thru them with no pre-existing conditions....worth checking into.

Jimbo
12-10-2009, 06:33 AM
Sounds so cruel to leave you like that :(

I do hope the health reforms kick in so you can get the surgery. We have public free health here in Australia, but I still get private health insurance, gives me freedom to choose my surgeon. You will probably want this option so try and get health insurance.

debbei
12-10-2009, 06:57 AM
Pilar,

I don't know about CA, but in NJ, if you go uninsured for a period of time (60 days I think) then it makes it much harder to get health insurance afterwards, and the insurance companies can use the 'pre-existing condition' excuse not to cover things.

I hope you can figure something out, and I'm sorry you had to go through all of this.

joyfull
12-10-2009, 06:56 PM
Pilar, I think you must look for another doctor! I can't believe that there are no doctors who will accept your insurance. My brother in law is a pharmacist in CA and knows lots of people. If you like, I can ask him for a recommendation if you send me a private message with more info.

Have you thought about teaching for a year? They usually have wonderful insurance. It would be worth it if it allowed you to have the surgery.

Good luck!

Karen Ocker
12-11-2009, 05:50 PM
Another idea would be to go to a teaching hospital's scoliosis clinic. Payment is on a sliding scale.


http://ortho.stanford.edu/

Try asking for the spine clinic.

http://stanfordhospital.org/clinicsmedServices/COE/orthopaedics/spineCenter/patientEducation/scoliosis.html

Shari
12-13-2009, 12:26 AM
Hi Pilar,

In my opinion, this thread should not be about the Health Care debate either.

I think you need to find another Dr. that's not so damn greedy. There are Doctor's in this country that care more about people than the "almighty dollar"!!!

For example, Dr. Boachie, from what I understand, goes overseas and performs this surgery for free, to the under privileged.

The Cleveland Clinic has a charity fund for these kind of circumstances, and I would find it hard to believe, that they are the only one. In fact, I used it.

Do not give up!!! There really are good people out there that truly care about the health of their patients.

I could go on and on about this subject, but I don't want to turn this important thread into a forum for debate. Please don't give up!!!

You are more than welcome to PM me or email me at kpsmr@aol.com.

You are worth the extra effort,
Shari